Steroid Shots Safe for Knee Arthritis

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Despite Concerns, Study Shows No Ill Effects on Cartilage By Jim Kling
WebMD Medical News Reviewed By Michael Smith, MD
on Thursday, February 06, 2003

Feb. 6, 2003 -- Many doctors have been reluctant to use steroid injections to treat knee arthritis for fear that it could worsen the disease. But new research is bringing great news for people suffering from osteoarthritis -- not only do the injections improve symptoms, they also appear to be safe when used over the long term.

A recent government report showed that 1 in 3 Americans has arthritis, with osteoarthritis being by far the most common form. But there are not many options for treating the stiffness and pain. Find out more information about what's being called an arthritis epidemic.

A study published in the February issue of Arthritis and Rheumatism, however, suggests regular steroid injections improve symptoms but don't hasten progression of disease.

The study followed two groups of patients, one receiving steroid injections every three months and the other receiving placebo injections of inactive saline solution. Both groups had the option of taking painkillers and nonsteroid anti-inflammatory drugs (NSAIDS) such as ibuprofen to control pain.

After one year, the steroid group had significantly better range of motion and reduced knee pain. But there was no difference in amount of joint cartilage -- suggesting that the steroids were not causing any damage.

After two years of injections, symptoms were only slightly better in the steroid group, but there was still no evidence of cartilage damage from the steroids.

"This is a very important result because it really addresses the concern ... about destruction of the joints produced by steroids," Felix Fernandez Madrid, MD, PhD, professor of medicine at Wayne State University, tells WebMD. Knee osteoarthritis is generally treated by a combination of approaches, he says, including weight lifting to improve the strength of the quadriceps muscle, weight loss when appropriate, and pain medicines.

Steroid injections are one option, but patients may balk because they've heard about all of the side effects of steroid use, such as osteoporosis and stomach ulcers. But treatment of knee osteoarthritis involves injections directly into the joint, not to be confused with steroid pills that have effects all over the body, says Madrid. The study showed no such side effects.

Doctors may be concerned that steroids could indirectly cause further cartilage damage because pain relief might encourage a patient to put more weight on the knee. But that possibility is theoretical, and the current study argues against it. Still, it isn't the final word, according to study researcher Jean-Pierre Raynauld, MD.

The study involved only 68 patients, and it's possible that small amounts of damage weren't detected. "We have to be careful about saying that [steroid injections] have been proven safe beyond a shadow of a doubt," Raynauld, assistant professor of medicine at the University of Montreal, tells WebMD.

To answer the question, Raynauld plans to conduct another clinical trial, this time using MRI to gauge the condition of patients' knees. The technique is more sensitive than the X-rays used in this trial and could provide more convincing proof.

But in the meantime, it appears that the pain relief that steroid shots frequently offer does not come at the expense of cartilage. "For patients and physicians, [the trial] should definitely be reassuring," says Raynauld.

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SOURCES: Arthritis & Rheumatism, February 2003 • Felix Fernandez Madrid, MD, PhD, professor of medicine, Wayne State University, Detroit • Jean-Pierre Raynauld, MD, assistant professor of medicine, University of Montreal.